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Chronic low back pain w/ L5 radiculopathy - Discogram, or another MRI?

kevn1115kkevn1115 Posts: 20
Hello -

I posted here for the first time a while ago, and couldn't locate my original thread, so I'm posting a new question. I've had chronic low back pain for approx. 3 years, and for the last 10 months or so, have started having pain going down both legs and into my calves. I recently had an EMG/NCV study done, and the neuro diagnosed me with L5 radiculopathy. She has given me a referral to a pain management center for treatment. Up till now, I've had 3 MRI's and have two small bulges (~2-3mm) at L4/L5, and at L5/S1. I've had a total of 5 ESI's over the last 3 years, with no relief at all. I was planning on having a discogram performed, to confirm what the source of my low back pain was.

Here's the twist. Up till now, all of my MRI's have been lumbar spine MRI's. I have felt some tightness/pain in the middle of my spine, I guess that would be the thoracic area. I've never had an MRI of that area, nor of my sacrum; just the lumbar has been looked at. Should I have another MRI for my entire spine, just to make sure there's nothing else going on that I don't know about? Or should I just proceed with having a discogram of the lumbar area? My line of thinking was it would be critical to know if there is anything else wrong with my spine prior to having the discogram procedure done. If other trouble spots were found, those could also be included in the discogram procedure.

I welcome any thoughts/advice on this. I know a good number of you have already had to unfortunately go through this. Thanks!



  • You might want to express your concerns to your doctor and see what tests he orders for you. I can tell you that unless you are having a surgery for something like scoliosis where most of the spine is involved, it is uncommon to work on more than one area at a time.

    Even if you have an entire body scan, the surgeon will say something like "well, there are some problems with the cervical discs but, let's concentrate on the lumbar problems first." Also, while you may find things wrong from a scan, it does not necessarily mean that they are causing you any pain or problems. Once we get out of our twenties, very few of us have textbook-perfect spines. But unless we have a MRI, we are not aware of the problems.

    Often the sacral area ends up getting scanned when they are scanning the lumbar area, so you may have had one, albeit unintentionally.

    Regarding the discogram, if you spinal specialist feels it is warranted, he will ask for one. Not everyone needs to have a discogram to be diagnosed. Some doctors request them all the time; others, almost never. There is some controversy surrounding that test, so I would leave it up to your doc unless you have some problem that you are sure is coming from a disc problem, and it is otherwise undiagnosable.

    Your symptoms all sound like they are stemming from that lower lumbar area. I would just wait to see what the new doctor needs in order to set up a plan of treatment for you. There's no point in getting MRIs too close together unless your symptoms suddenly change.

    Good luck getting a proper diagnosis.

  • Thanks for the advice Gwennie. The last 24 hours or so, I've been leaning toward scheduling a consultation with the Pain Management doctor that my neurologist referred me to. I think it makes more sense to see what they may be able to do for me before having the discogram done. I've had ESI's, but I haven't had facet joint injections, and I find the RF ablation procedure very interesting, if I were a candidate for it. I know that surgery is the absolute last resort when it comes to your spine. The thing that sucks is that I have the leg pain as well as the lower back pain. The good thing is that I mainly only have these symptoms while sitting. I can still be active and can walk and move around with no real issues. It's just the sitting/driving that are the problem positions. I'm hoping that maybe the PM doctor can find a way to treat both. I've read that usually the discogram is done after all other treatment methods have failed. Is that typically the case? Thanks again...
  • Discograms are done as a diagnostic procedure for determining if a disc is a pain generator. All other treatments had failed to this point to relieve the pain in my low back. I had L3-L4, L4-L5, & L5-S1 checked. This is not for the faint of heart. The first 2 disks were OK. At L5-S1 I cried and begged for them to stop. Then I tried to get off the table to leave. A shot of demoral calmed my down. Needless to say the next step was a fusion at that level. My pain level at that area went down after surgery.
    Your PM doc usually does this procedure. I had all the shots, RF burn, Chiro's, massage, swimming ect ect but in the end fusion. Good for me, but check all options first and get second opinions.
    Good luck,
  • Highwayman, thanks for your input. How did the RF burn work for you?
  • Good Morning,
    The RF burn did not help in my situation. That said in your body it may but that will be a decision you and your Doc determine.
  • Hello everyone. Last Friday I had an MRI of my thoracic spine for the first time, as I have had some nagging pain in my mid/upper back for a while, and wanted to confirm if anything was going on in that region. Below are the results of the MRI:

    The bone marrow signal intensity is normal.

    T6-7: There is mild loss of disc signal without bulge or protrusion, canal or foraminal stenosis.

    T7-8: There is mild loss of disc signal with a 2-mm left central protrusion without cord compression, canal or foraminal stenosis.

    T8-9: There is moderate loss of disc height and signal intensity with a 3 to 4-mm right central extrusion, which mildly flattens the anterior thecal sac slightly indenting the right anterior aspect of the cord. There is mild facet hypertrophy but no overall canal stenosis. The neural foramina are patent.

    The remainder of the thoracic levels are normal.

    Am I correct in reading that the disc at T8-9 has ruptured? I looked up extrusion and it indicated that is when the disc is actually leaking nuclear material. Anyone else have this same type of finding on their MRI? I'm scheduled for some diagnostic nerve blocks at L4-L5 on 11/11, but will likely call my PM dr. and advise him of this new information. Can something like this even be handled through PM? Thanks in advance for your help.

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